Adaptable obturator for various sized trocars

ABSTRACT

Surgical access systems and obturators for or used in surgical access systems are provided. The obturator is configured to operate or accommodate the use of at least two different sized trocars. The outer diameter of the adaptable obturator when inserted into a trocar compresses from an initial condition to a compressed condition to match the inner diameter of the trocar.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.13/752,045, filed Jan. 28, 2013, which claims the benefit of U.S.Application No. 61/592,931, filed on Jan. 31, 2012, the entiredisclosures of which are hereby incorporated by reference as if setforth in full herein.

BACKGROUND

This application relates generally to surgical access systems and, morespecifically, to obturators for or used in surgical access systems.

Surgical access systems facilitate minimally invasive surgery across abody wall and within a body cavity. For example, in abdominal surgery,trocars alone or in conjunction with other access devices provide aworking channel across the abdominal wall to facilitate the use ofinstruments within the abdominal cavity. Trocar systems can include acannula, which provides the working channel, and an obturator that isused to place the cannula across a body wall, such as the abdominalwall. The obturator is inserted into the working channel of the cannulaand pushed through the body wall with a penetration or insertion forceof sufficient magnitude to result in penetration of or entry through thebody wall. Once the cannula has traversed the body wall, the obturatorcan be removed.

With the cannula in place, various instruments may be inserted throughthe cannula into the body cavity. One or more cannulas may be usedduring a procedure. These cannulas or trocars may be of different sizes,e.g., different diameters and lengths, to accommodate different sized ordimensioned instruments. Using an arrangement of trocars versus usingthe largest sized trocar is often more desirable to minimize trocar sitedefects and the invasiveness of the surgical procedure. Additionally,the largest sized trocars often do not accommodate small sizedinstruments as for example the instrument seals of such trocars are notsufficient to prevent the escape of gas when such small sizedinstruments are used. During the procedure, the surgeon manipulates theinstruments in the cannulas, sometimes using more than one instrument ata time. A reduction in insertion force of a trocar into the body cavityis desired to prevent, reduce or eliminate uncontrolled entry into thebody cavity and potential damage to organs, tissue or other priorinserted devices in the cavity and the incision or surgical access site.

SUMMARY

Generally, an obturator is provided to operate or accommodate the use ofat least two different trocars. In one embodiment, an obturator isconfigured to be insertable into a trocar cannula. The obturator mayinclude an elongate shaft having a proximal end and a distal end, ahandle at the proximal end of the elongate shaft, a tip at the distalend of the elongate shaft, and a compressible portion at the tip of theshaft, the compressible portion provided to operate and accommodate theuse of at least two different sized trocars.

In one embodiment, a trocar system is provided. The system comprises afirst trocar having a seal assembly and a cannula with a diameter and alength and a second trocar having a seal assembly and a cannula with adiameter larger than the diameter of the first trocar and a lengthgreater than the length of the first trocar. The system comprises anadjustable obturator having a compressible portion in an initial stateconfigured to have a diameter greater or equal to the diameter of thesecond trocar and in a compressed state configured to have a diametergreater or equal to the diameter of the first trocar and having adiameter smaller than the diameter of the second trocar.

These and other features of the invention will become more apparent witha discussion of embodiments in reference to the associated drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present inventions may be understood by reference to the followingdescription, taken in connection with the accompanying drawings in whichthe reference numerals designate like parts throughout the figuresthereof

FIG. 1A is a side view of an obturator in accordance with variousembodiments of the present invention.

FIG. 1B is a side view of an obturator in accordance with variousembodiments of the present invention.

FIG. 1C is a side view of an obturator in accordance with variousembodiments of the present invention.

FIG. 1D is a perspective view of an obturator in accordance with variousembodiments of the present invention.

FIG. 1E is a perspective view of an obturator in accordance with variousembodiments of the present invention.

FIG. 2 illustrates exploded views of two exemplary trocars in accordancewith various embodiments of the present invention.

FIG. 3 is a side view of an obturator in accordance with variousembodiments of the present invention.

FIG. 4 illustrates side views of the proximal portions of the exemplarytrocars in accordance with various embodiments of the present invention.

FIG. 5 illustrates side views of the instrument seals of the exemplarytrocars in accordance with various embodiments of the present invention.

FIG. 6 is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 7 is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 8 is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 9A illustrates side views of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 9B is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 10 is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 11 is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 12A is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 12B is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 12C is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 13 is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 14 is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 15-1 is a side view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 15-2 is a bottom view of an obturator in accordance with variousembodiments of the present invention.

FIG. 15-3 is a perspective view of an obturator in accordance withvarious embodiments of the present invention.

FIG. 15-4 is a side view of an obturator in accordance with variousembodiments of the present invention.

FIG. 15-5 is a side view of a compressed obturator in accordance withvarious embodiments of the present invention.

FIG. 15-6 is a cross-sectional view of an obturator and an exemplarysmall trocar in accordance with various embodiments of the presentinvention.

FIG. 15-7 is a cross-sectional view of an obturator and an exemplarylarge trocar in accordance with various embodiments of the presentinvention.

FIG. 15-8 is a side view of an obturator and an exemplary large trocarin accordance with various embodiments of the present invention.

FIG. 15-9 is a cross-sectional view of an obturator and an exemplarylarge trocar in accordance with various embodiments of the presentinvention.

FIG. 15-10 is a perspective view of an obturator and an exemplary largetrocar in accordance with various embodiments of the present invention.

FIG. 15-11 is a bottom view of an obturator and an exemplary largetrocar in accordance with various embodiments of the present invention.

FIG. 15-12 is a perspective view of an obturator and an exemplary smalltrocar in accordance with various embodiments of the present invention.

FIG. 15-13 is a bottom view of an obturator and an exemplary smalltrocar in accordance with various embodiments of the present invention.

FIG. 15-14 is a cross-sectional view of an obturator and an exemplarysmall trocar in accordance with various embodiments of the presentinvention.

FIG. 15-15 is a side view of an obturator and an exemplary small trocarin accordance with various embodiments of the present invention.

FIG. 16 is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 17A is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 17B is a side view of an embodiment of an obturator in accordancewith various embodiments of the present invention.

FIG. 18 is a perspective view of another embodiment of an obturator inaccordance with various embodiments of the present invention.

FIG. 19 is a side view of a distal portion of another embodiment of anobturator in accordance with various embodiments of the presentinvention.

FIGS. 20-22 are perspective views of various embodiments of accessdevices in accordance with various embodiments of the present invention.

DETAILED DESCRIPTION

An obturator is provided to operate or accommodate the use of at leasttwo different trocars. For example, a first trocar, e.g., a 5-10 mmtrocar, and a second trocar, e.g., a 5-12 mm trocar, are provided anddiffer in that the first trocar has an inner diameter that is smallerthan the inner diameter of the second trocar to accommodate smallerdiameter surgical instruments inserted therethrough. The first trocar isalso shorter than the second trocar.

The obturator is compressible such that it can adjust to the differentsizes posed by the at least two different trocars. For example, theouter diameter of the obturator when fully expanded or in its initialcondition matches or mates with the inner diameter of the second“larger” trocar. The outer diameter of the obturator when inserted intothe first trocar compresses from this initial condition to a compressedcondition to match the inner diameter of the first trocar. The matchingof the diameter of the obturator and the trocar or cannula removes tipwobble or general movement of the obturator and/or tip as the trocar isbeing inserted and thus facilitates insertion and placement of thetrocar. Gaps or spacing within the shaft and/or compressible and/orelastic material incorporated into or coupled to the shaft of theobturator facilitates the compressibility of the obturator.

The single adjustable or adaptable obturator thereby replaces the needto provide at least two different sized obturators to accommodate the atleast two different sized trocars and thus obviates the potentialproblem of using the wrong obturator with a particular trocar therebyavoiding for example operating room confusion. Additionally, savings inmanufacturing, distribution and operational costs are realized. Forexample, packaging space that would be used for multiple obturators canbe reduced to provide a single obturator and the cost savings inproviding a single obturator instead of multiple obturators can also besignificant.

Referring now to the figures, FIGS. 1A-1E provides various views of anobturator in accordance with various embodiments of the presentinvention. The obturator includes a handle 10 at the proximal portion orend of the obturator. The handle is graspable by a user, e.g., asurgeon, to insert and withdraw the obturator from a trocar and providesa base or support for a user to push the obturator against the trocar.The obturator includes a tip 18 at the distal end of the obturator andas illustrated is blunt and pointed. In various embodiments, the tip isrounded, sharp or otherwise dimensioned and shaped as desired orwarranted by the surgical procedure or operational conditions of the useof the trocar and/or obturator.

Between the tip 18 and the handle 10 of the obturator is a core seal 14.The core seal 14 seals against the aperture of an instrument seal of atrocar. The core seal as illustrated is cylindrical and seals againstone or more instrument seals of one or more different sized trocars,e.g., first or second trocars. As such, the diameter and length of thecore seal is sufficient to effectuate such a seal.

Near the handle or proximal portion of the obturator, the obturator hasan abutment or depth limiter 12 such that the most distal portion of thedepth limiter will contact the cap of the first trocar to preventfurther insertion of the obturator. A second or more proximal portion ofthe depth limiter is larger in diameter than the distal portion of thedepth limiter and contacts the cap of the second trocar to preventfurther insertion of the obturator. As such, whether a first or secondtrocar is used, the same amount of the tip portion of the obturator,e.g., portion L1 (FIG. 3), extends out the distal end of either trocarand thereby the same tip geometry relative to the trocars remains thesame. By keeping both tip geometries the same or nearly the same, theinsertion force needed to insert the obturator and trocar into thesurgical site or access device remains the same or substantially similarand thus the same or substantially similar tactile feedback ismaintained upon or during insertion of either different trocar using thesame obturator. In one embodiment, the differences are shown at theproximal end of the obturator where a portion of the obturator extendsfurther out from the proximal end of the trocar when the obturator isused with the smaller of the at least two trocars. The core seal 14however ensures that the proximal end differences does not effect theseal between the obturator and the instrument seal which may becomenoticeable when the obturator and trocar are inserted into a surgicalsite or device under insufflation gas pressure.

The obturator also includes an adjustable, compressible and/orexpandable portion and in various embodiments takes the form of ribs 16.The ribs 16 are spaced circumferentially around a center shaft of theobturator and separated from the center shaft by gaps 15. As shown, theribs 16 extend from the core seal 14 to the tip 18. Four equally spacedribs around the center shaft or longitudinal axis of the obturator areprovided with obturator 2. Fewer or more ribs may be provided but arearranged such that the diameter defined by the one or more ribs to matewith the inner diameters of the various trocars to be used with thesingle obturator. The mating or conforming of the ribs 16 with thevarious sized trocars ensures that the obturator remains snug or closelyfitted into the different sized trocars and thereby removing potentialwobble or movement of the obturator within the trocar as the obturatorand trocar are being inserted into the surgical site or through anotheraccess device.

In one embodiment, the ribs 16 in an initial or relaxed state are fullyexpanded and thus define or delimit a specific diameter. The specificdiameter in one embodiment is equal to or is larger than the innerdiameter of the largest sized trocar to be used with the obturator. Theribs 16 are compressible or can otherwise assume a flattened ornon-expanded form or state and thus define or delimit another smallerdiameter. This smaller diameter is equal to or greater than the innerdiameter of the smallest sized trocar to be used with the obturator. Theribs 16 in one embodiment can assume a state or condition between thenon-expanded and expanded form to define diameters between the smallestand largest sizes and thus can conform to the various inner diametersizes of various different sized trocars between the smallest sizedtrocar to the largest sized trocar. The ribs 16 also being adjustableallows for changes within the inner diameter of the trocar that can varywithin the trocar. For example, the inner diameter could be larger atthe proximal end versus the diameter near the distal end or varythroughout the length of the trocar. The adjustability of the ribsthereby prevents the obturator from being snagged or otherwise blockeddue to variances in the inner diameter throughout the trocar.

In one embodiment, the gap or space 15 between the rib and the centershaft of the obturator defines the compressibility or expandability ofthe obturator and thereby delimits the diameter and/or circumferencedefined. The mating of the ribs with the inner diameter of the trocaralong with the core seal also limits potential movement or wobble due toproximal end differences of the trocar when inserted into differentsized trocars.

In FIG. 2, two exemplary trocars are shown. It should be appreciatedthat multiple other trocars could be described with various otherdifferences in size, shape and with more or less components provided inFIG. 2. Thus, the trocars provided should be viewed as non-limitingexamples of trocars that can be accommodated by the various embodimentsof the obturators described herein. As shown, trocar 4 is smaller thantrocar 6 and thus is smaller in length and accommodates a smallerdiameter or range of small instrument diameters versus the larger trocar6. Each trocar includes a cap 21, 22; a seal protector 23, 24; aninstrument or septum seal 25, 26; and zero seals 27, 28. The protectorsand seals are disposed between a cap 21, 22 and trocar housing 29, 30.The instrument or septum seal seals the working channel of the trocarwhen an instrument is in place, and a zero closure valve or zero sealseals the working channel when the instrument is removed or in theabsence of an instrument.

It should be appreciated that the trocar as described throughout mayinclude a seal or valve housing coupled or attached to a cannula withthe valve housing holding the instrument seal and/or zero seal. Thecannula is affixed or removably connected to the valve housing. Thecannula in one embodiment may hold the zero seal or portions of theinstrument and/or zero seal may extend into a portion of the cannula.Also, the housing and cannula could be combined or formed into a singleincorporated or monolithic structure thereby making where the housingends and the cannula begins indistinguishable. The instrument and zeroseals in various embodiments may also be combined or formed as a singleseal. The cannula may include ribs, threads, projections or retainersalong or at the distal end of the cannula to hold or retain the cannulawithin the surgical site and/or an access device. In variousembodiments, the trocar is a monolithic structure with seals providedwithin a proximal portion of the trocar. Also, in various embodiments,the trocar is rigid and not bendable.

As illustrated, the overall trocar length of the first trocar is smallerthan the overall trocar length of the second trocar and for exemplarypurposes for parts of the description the first trocar represents thesmallest trocar to be used with the obturator and the second trocarrepresents the largest trocar to be used with the obturator. The innerdiameter of the first trocar is also smaller than the inner diameter ofthe second trocar. The overall length of the obturator as provided invarious embodiments is larger than the first and second trocars withproximal and distal portions of the obturator extending beyond therespective proximal and distal ends of the trocars with the obturatorinserted therethrough.

Referring now also to FIGS. 3-5, in one embodiment, the obturator in aninitial or expanded (partially or fully) state defines a diameter and/orwidth D1 that is equal to or greater than the inner diameter of thelargest cannula to be used with the obturator. As such, in one state orcondition the obturator defines or delimits a diameter and/or width D1that is equal to or greater than the inner diameter of the largestcannula to be used with the obturator. Additionally, in a separate stateor condition, the obturator defines or delimits a diameter and/or widththat is equal to or greater than the inner diameter of the smallestcannula to be used with the obturator. This second defined diameter issmaller than the diameter D1. The obturator in various embodiments mayhave various other states or conditions between these two states orconditions in which the obturator defines or delimits a diameter and/orwidth that smaller than the inner diameter of the largest cannula to beused with the obturator (or diameter D1) and larger than the innerdiameter of the smallest cannula to be used with the obturator.

The overall length OL of the obturator remains constant. The steppedportion or depth limiter 12 in one embodiment defines or includes one ormore expanded portions. For example, a first expanded portion ispositioned a first length L3 measured starting from the tip or distalmost portion of the obturator to a position on the obturator past thecore seal 14. The first length L3 is smaller than the overall length OL.A second expanded portion is positioned a second length L4 measured fromthe tip or distal most portion of the obturator to a position on theobturator past the core seal 14.

In various embodiments, the first and/or second expanded portions arepositioned ahead of or adjacent to the handle portion 10 of theobturator 2. In one embodiment, the first and/or second expandedportions are blended into or formed as part of the handle portion 10 ofthe obturator 2. As such, the handle portion 10 defines a first and/orsecond expanded portion. In one embodiment the depth limiter is taperedor graduated having or defining a first distal diameter and graduating,tapering or having steps to one or more larger sections, portions,flanges or abutments having or defining one or more larger proximaldiameters.

The first expanded portion abuts against the cap or proximal portion ofthe valve housing or trocar of the smallest cannula to be used with theobturator when the obturator is inserted into the trocar. However, thefirst expanded portion does not abut against the cap or proximal portionof the valve housing or trocar of the largest trocar or a larger trocarthan the smallest trocar when the obturator is inserted into thistrocar. In one embodiment, the first expanded portion moves pass the capor proximal portion of the largest trocar and a second expanded portionabuts against the cap or proximal portion of the trocar of the largesttrocar.

The first expanded portion of obturator 2 as illustrated defines a firstdiameter D3 that is smaller than the diameter D4 defined by the secondexpanded portion. The first diameter D3 equals or is larger than thediameter of D11 of the proximal portion or cap of trocar 4 and trocar 4for exemplary purposes represents the smallest trocar to be used withthe obturator. As such, when the obturator is inserted into the trocar,the first expanded portion contacts the cap or outer surface of the capof the trocar to prevent further distal or insertion of the obturatorinto the trocar. The first diameter D3 is however smaller than thediameter of D12 of the proximal portion or cap of trocar 6 and trocar 6for exemplary purposes represents the largest trocar to be used with theobturator or at least larger than the first trocar. When the obturatoris inserted into trocar 6, the first expanded portion does not contactthe cap or outer surface of the trocar and thus travels further into thetrocar 6. The second expanded portion of the obturator as illustrateddefines a second diameter D4. The second diameter D4 is greater than thefirst diameter D3 and the diameter D11 of the trocar 4. The seconddiameter D4 equals or is larger than the diameter of D12 of the proximalportion or cap of trocar 6. Thus, when the obturator continues to beinserted into the trocar 6, the second expanded portion contacts the capor outer surface of the cap to prevent further distal movement orinsertion of the obturator into the trocar 6. Accordingly, the obturatoris allowed to or is not restricted from advancing farther into a trocarwith a larger inner diameter than a trocar with a smaller innerdiameter.

In one embodiment, the portion of the obturator extending out from thedistal end of the smallest cannula with the obturator fully insertedthere through and the portion of the obturator extending out from thedistal end of the largest cannula with the obturator fully insertedthere through are the same. As such, the same tip geometry (e.g., shape,dimensions, length, width and/or diameter) is provided by the obturatoreven though different length trocars or cannulas are used. For example,in the illustrated embodiment, the distal length L1 of the obturator 2that would extend out from the distal end of trocars 4 and 6, forexample, remains the same even with the overall lengths of the trocarsbeing different. The tip of the obturator in one embodiment with theobturator fully inserted within various sized trocars has or defines anouter surface or circumference that is flushed with the distal end ofthe trocar. As provided in the illustrated embodiment, the length oftrocar 4 is smaller than the length of the trocar 6 with both trocarlengths being smaller than the overall length of the obturator 2.

The length L2 of the core seal 14 in one embodiment is equal or largerthan the difference in length L3 and L4 as defined by the respectivefirst and second expanded portions of the obturator. As such, the lengthof the core seal ensures that the outer surface of the obturator abutsagainst the aperture of the instrument seals of the various sizedtrocars to ensure that a seal is maintained between the obturator andthe instrument seal. The position of the core seal along the obturatorcan vary and depends on the size, placement and/or dimensions of theinstrument seal and/or the aperture or opening of the instrument seal ofthe various trocars. In various embodiments, the length of the core sealcan also be increased to account for such variations in the instrumentseals of the various trocars. The size or dimensions of the core sealcan vary to reduce the amount of material utilized to form the coreseal, to increase/decrease the size or dimensions of the depth limiterand/or the compressible portion to increase/decrease compressibilityand/or to accommodate different trocar lengths, housing sizes or shapesand/or to avoid restricting or interfering with the depth limiter and/orthe compressible portion.

The diameter D2 of the core seal 14 is equal or greater than thediameter D21 and D22 of the apertures through the instrument seals 25,26. As such, the core seal with the obturator inserted into the trocarmaintains a seal against the aperture of the various sized instrumentseals of the various sized trocars to be used with the obturator.

In FIG. 6, the depth limiter or stepped portion 121 may be morepronounced or have a similar geometry as the ribs 16. In one embodimentthe depth limiter may includes ribs. As such, the ribs of the depthlimiter are readily manufactured similar to the compressible portion.The ribs of the depth limiter in one embodiment provide one or moreexpanded portions to limit the insertion of the obturator through asmaller sized trocar while also allowing or not restricting further orgreater advancement of the obturator into larger sized trocars.Additionally, in one embodiment, the obturator ensures the distalportion extending out from the trocar remains unchanged even though thetrocar sizes are different. The depth limiter in one embodiment canextend or be incorporated into the handle 10 as shown for example inFIG. 7. Such an extension 123 of the handle 10 can ease manufacturing ofthe depth delimiter or stepped portion. In FIG. 8, the stepped orexpanded portion includes a disc 124 or a similar middle portion betweenfirst and second expanded portions 122 and 126 or to replace one of theexpanded portions. The disc 124 can be used to clearly define orindicate the stop insertion point of the obturator relative tospecifically sized trocar and/or to reduce material costs. For example,a first range of specific sized trocars would have the obturator stop atthe first expanded portion, a second range at the disc 124 and a thirdrange at the second expanded portion. As such, a similar look and feelof the obturator with the trocar will be provided to the surgeonregardless of the size of the trocars or the different sizes of thetrocars relative to the same obturator.

In one embodiment, as shown in FIGS. 9A-9B, ribs 16 are positioned onsymmetrically opposed sides of the obturator or only one rib, rib 16, ispositioned on only one side to ease manufacturing. The single rib in oneembodiment is larger or sized to occupy a larger portion of the innerdiameter of the trocar relative to a plurality of ribs as the opposingportion of the shaft of the obturator is constant or unable to adjust inwidth or radially. The plurality of similarly sized and opposed ribs inone embodiment maintains a particular center or position of the tiprelative to the distal end of the trocar. The rib or ribs remaincompressible against the center shaft of the obturator to conform ormate with the small sized trocars and yet expandable to conform or matewith the large sized trocars thereby reducing or eliminating tip wobble.In FIG. 10, the gap between the ribs 16 are shortened to form gaps 151.In the illustrated embodiment, the compression or expansion of the ribs16 may be limited by the shortened gaps 151 but also the tip or distalportion of the obturator could be strengthen. FIG. 11 illustrates theembodiment of the ribs or the portions thereof 161 that are separablefrom the shaft portion 163 of the obturator and thus assembled later toease manufacturing of the components of the obturator. Additionally,different rib patterns or sizes, e.g., how much the ribs can expand orcompress and be interchanged or swapped, can be utilized to increase therange of the options of providing a single obturator for multiple anddifferent sized trocars. For example, a first rib set could be used fora specific range of sized trocars and a second different rib set couldbe used for a different specific range of sized trocars.

In FIGS. 12A-12C, embodiments of flaps or leaves included with theobturator shaft in place of or to further enhance the ribs of theobturator to conform to different sized trocars are shown. The flaps orleaves are compressible in one embodiment and thus fold or spiralagainst the center shaft of the obturator when the obturator is insertedinto a small sized trocar. The flaps splay outward from the shaft of theobturator to conform the inner diameter of larger sized trocars. In FIG.12A, the flaps 164 are used instead of the ribs 16 and extend from thecenter shaft and FIG. 12B, the flaps 165 extend from raised portionsalong the center shaft of the obturator. In FIG. 12C, the flaps 166 aredisposed between the raised portion and in one embodiment extend from orare disposed between ribs of the obturator.

In one embodiment, a separate sleeve or insert is fitted against theouter surface of the obturator to adjust and thereby conform todifferent sized trocars. As such, in FIG. 13, ribs 171 extend from acircular retainer 172 attachable to the tip or near the tip of theobturator. The ribs 171 in an expanded or initial state conforms to alarge sized trocar and in a compressed state conforms or defines adiameter thereof of small or smaller sized trocars. In FIG. 14, a ribsleeve 173 includes ribs 174 and is attachable to the shaft of theobturator. The ribs of the rib sleeve are compressible and expanded toconform to the diameters of the various sized trocars.

In one embodiment, a elastic taper similar to the rib sleeve 173 with orwithout ribs is provided coupled to a proximal end of an inner shaft ofthe obturator, extending about the inner shaft and having a free endnear a distal end of the inner shaft. The inner shaft connects the tipand an outer shaft of the obturator. In one embodiment, a diameterdifference between the inner shaft and the outer shaft accommodates thetaper when compressed against the inner shaft. The elastic semi-conicalor taper is radially compressible such that the taper in contact with aninner diameter of trocar moves towards the central shaft of theobturator with the central shaft including the inner and outer shafts.The taper in an expanded or initial state conforms to a large sizedtrocar and in a compressed state conforms or defines a diameter thereofof small or smaller sized trocars.

In one embodiment, the taper or sleeve is an elastic membrane or capsulethat is filled with air, fluid or some other fillable material and in afilled or initial state conforms to a large sized trocar and in acompressed state conforms or defines a diameter thereof of small orsmaller sized trocars. The tip of the trocar is offset, twisted or isdesigned to traverse tissue without cutting. The tip in one embodimentis arranged to move along overlapping and perpendicular tissue planeswithout cutting. The taper or sleeve coupled to the tip conforms to thedistal end of the trocar whether the trocar is a large sized trocar or asmall or smaller sized trocar and thereby prevents coring of tissue andmaintaining the benefit of a particular tip. For example, themaintenance of the tip a specific distance from the distal end of thetrocar ensures visibility; ensures tip cutting (blade clearance) and/orensures gas pathway clearance. In one embodiment, the elastic taper isincluded with the ribs. In such embodiments, the elastic taper coversthe ribs or portions thereof and act as a mechanical reinforcement tothe elastic taper. In accordance with various embodiments, additionalmechanical reinforcement can be provided via scaffolding, lattices,compressible material or the like to enhance or adjust thecompressibility and/or expandability of the adjustable portion of theobturator.

Referring now to FIGS. 15-1 to 15-15, in which an adjustable obturatorwith a compressible sleeve is described in detail in relation withvarious sized trocars. It should be appreciated that the detailsprovided are exemplary and can be applicable to other various sizedtrocars not explicitly shown or described and likewise other obturatorsor combinations of embodiments and features or aspects of variousembodiments or combinations of embodiments described can also beapplicable to the various sized trocars described herein and othersimilar trocars not explicitly shown or described. A compressible sleeve235 in one embodiment is bulbous and made of compressible materialincorporated with or connectable to the shaft 232. The compressiblesleeve 235 is radially compressible such that the sleeve 235 in contactwith an inner diameter of a trocar moves towards the shaft or centralaxis of the obturator. The sleeve 235 in an expanded or initial stateconforms to a large sized trocar and in a compressed state conforms ordefines a diameter thereof of small or smaller sized trocars. The tip238 is offset, twisted or is designed to traverse tissue withoutcutting. The tip in one embodiment is arranged to move along overlappingand perpendicular tissue planes without cutting tissue. The sleeve 235,positioned at the tip, conforms to the distal end of the trocar whetherthe trocar is a large sized trocar or a small or smaller sized trocar tofill in or avoid undercuts or spacing between the distal open end of thetrocar and the tip of the obturator to thereby prevent coring of tissueand maintaining the benefit of a particular tip. For example, themaintenance of the tip a specific distance from the distal end of thetrocar ensures visibility; ensures tip cutting (blade clearance) and/orensures gas pathway clearance. In one embodiment, the compressiblesleeve is made of open-cell foam, memory foam or the like. In variousembodiments, the compressible sleeve is preformed and/or provides noconvention to operationally inflate, fill or externally adjust thecompressive sleeve thereby avoiding potential operational andmanufacturing complexities and difficulties.

In one embodiment, the obturator 2′ in an initial expanded ornon-compressed state defines a diameter and/or width D1′ that is equalto or greater than the inner diameter of the largest cannula, e.g.,cannula 244, to be used with the obturator. In a separate state orcondition, the obturator defines or delimits a diameter and/or widthD10′ that is equal to or greater than the inner diameter of the smallestcannula, e.g., cannula 245, to be used with the obturator. This seconddefined diameter D10′ is smaller than the diameter D1′. The obturator invarious embodiments may have various other states or conditions betweenthese two states or conditions in which the obturator defines ordelimits a diameter and/or width that smaller than the inner diameter ofthe largest cannula, e.g., cannula 244, to be used with the obturator(or diameter D1′) and larger than the inner diameter of the smallestcannula, e.g., cannula 245, to be used with the obturator.

The overall length OL′ of the obturator remains constant. The steppedportion or depth limiter 12′ in one embodiment defines or includes oneor more expanded portions. For example, a first expanded portion ispositioned a first length L3′ and a second expanded portion ispositioned a second length L4′ both measured relative to the tip ordistal most portion of the obturator to the respective expandedportions. In one embodiment, the lengths are measured relative to adistal portion of the obturator that substantially equals or correspondsto the distal end of one or more of the various sized trocars throughwhich the obturator extends there through when fully inserted into thetrocar or trocars. The first and second lengths are smaller than theoverall length of the obturator.

In various embodiments, the first and/or second expanded portions 125,127 are positioned ahead of or adjacent to the handle portion 10′ of theobturator 2′ and in various embodiments the first and/or second expandedportions are blended into or formed as part of the handle portion 10′ ofthe obturator 2′. As such, the handle portion 10′ defines a first and/orsecond expanded portion. In one embodiment the depth limiter is taperedor graduated having or defining a first distal diameter, e.g., diameterD3′, and graduating, tapering or having steps to one or more largersections, portions, flanges or abutments having or defining one or morelarger proximal diameters, e.g., diameter D4′.

The first expanded portion 125 abuts against the cap or proximal portionof the valve housing 243 but does not abut against the cap or proximalportion of the valve housing 242 of a trocar larger than the trocar withthe valve housing 243. As such, the first expanded portion 125 passesthe cap or proximal portion of a larger or largest trocar while thesecond expanded portion 127 abuts against the cap or proximal portion ofthe trocar of the larger or largest trocar when the obturator isinserted into the trocar.

The first expanded portion of obturator 2′ as illustrated defines afirst diameter D3′ that is smaller than the diameter D4′ defined by thesecond expanded portion. The first diameter D3′ equals or is larger thanthe diameter of D11′ of the proximal portion or cap of trocar 4′ andtrocar 4′ for exemplary purposes represents the smallest trocar to beused with the obturator. As such, when the obturator is inserted intothe trocar, the first expanded portion contacts the cap or outer surfaceof the cap of the trocar to prevent further distal or insertion of theobturator into the trocar. The first diameter D3′ is however smallerthan the diameter of D12′ of the proximal portion or cap of trocar 6′and trocar 6′ for exemplary purposes represents the largest trocar to beused with the obturator or at least larger than the first trocar. Whenthe obturator is inserted into trocar 6′, the first expanded portiondoes not contact the cap or outer surface of the trocar and thus travelsfurther into the trocar 6′. The second expanded portion of the obturatoras illustrated defines a second diameter D4′. The second diameter D4′ isgreater than the first diameter D3′ and the diameter D11′ of the trocar4′. The second diameter D4′ equals or is larger than the diameter ofD12′ of the proximal portion or cap of trocar 6′. Thus, when theobturator continues to be inserted into the trocar 6′, the secondexpanded portion contacts the cap or outer surface of the cap to preventfurther distal movement or insertion of the obturator into the trocar6′. Accordingly, the obturator is allowed to or is not restricted fromadvancing farther into a trocar with a larger inner diameter than atrocar with a smaller inner diameter.

In one embodiment, the portion of the obturator extending out from thedistal end of the smallest cannula with the obturator fully insertedthere through and the portion of the obturator extending out from thedistal end of the largest cannula with the obturator fully insertedthere through are the same. As such, the same tip geometry (e.g., shape,dimensions, length, width and/or diameter) is provided by the obturatoreven though different length trocars or cannulas are used. For example,in the illustrated embodiment, the distal length L1′ of the obturator 2′that would extend out from the distal end of trocars 4′ and 6′, forexample, remains the same even with the overall lengths of the trocarsbeing different. The tip of the obturator in one embodiment with theobturator fully inserted within various sized trocars has or defines anouter surface or circumference that is flushed with the distal end ofthe trocar. As provided in the illustrated embodiment, the length oftrocar 4′ is smaller than the length of the trocar 6′ with both trocarlengths being smaller than the overall length of the obturator 2′.

In one embodiment, ribs 16 are included with the compressible sleevewith the sleeve covering the ribs 16. In other embodiments, thecompressible sleeve includes slots or opening through which the ribs 16are exposed or protrude out from the sleeve. In other variousembodiments, the compressible sleeve is a plurality of individualsections or wedges that fill in portions between the ribs. In oneembodiment, the compressible sleeve is porous and provides a gaseouspathway through the compressible sleeve and out the distal end of thetrocar. In one embodiment, the porous compressible sleeve is used forinitial insufflation and replaced with a non-porous compressible sleevewhen a gaseous pathway is not desired. In accordance with variousembodiments, the compressible sleeve or portions thereof is preformedinto a specific shape and/or dimension to conform to the obturator tipand the various diameter sizes of the distal ends of the various sizedtrocars.

In the illustrated embodiment and applicable to various otherembodiments, the distal portion of the compressible sleeve can betapered or more resilient, e.g., made of a material more resilient orcompressible than other portions of the sleeve, to facilitate insertionof the obturator into the various sized trocars by reducing friction orotherwise minimizing contact of the distal portion of the compressiblesleeve with the inner diameter or portion of the trocar including forexample various seals, valves, housings and cannulas. Similarly, in theillustrated embodiment and applicable to various other embodiments, theproximal portion of the compressible sleeve can be tapered or moreresilient, e.g., made of a material more resilient or compressible thanother portions of the sleeve, to facilitate removal or withdrawal of theobturator from the various sized trocars.

Referring now to FIGS. 16-19, gapped or opened ribs are shown along anobturator. In FIG. 16, the ribs 181 are curvilinear and extend up to agap portion separating the proximal end of ribs 181 with a sectioned orprong portion 183 of the obturator. The gapped ribs can increasecompressibility or expandability of the ribs and reduce overall diametersize of the obturator. The gapped ribs 185, 187 with respective prongportions 186, 188 as shown in FIGS. 17A-B and 18 are more pronounced,peaked and/or curved and can further increase compressibility orexpandability of the ribs. The prongs capture the proximal ends of thegapped ribs to prevent the ends from splaying and thus snagging againstan inner surface or portion of the trocar. FIG. 19 illustrates ribs 189with prongs 190 which are similar to the ribs 16 previously describedwith ribs 189 having a similar shape and size as the ribs 16 with a gapformed or cut out along the rib to form the prongs 190.

In various embodiments, the obturator includes a tip skirt coupled tothe shaft at the distal end of the obturator and near the tip. The tipskirt fills in spacing between the tip of the obturator and the distalopen end of the trocar. As such, the tip skirt provides a smooth,uniform and/or consistent transition from the obturator tip to theperiphery of the distal open end of the trocar. Therefore, regardlesshow long the trocar is relative to the obturator or how wide or largethe diameter of the distal open end of the trocar is relative to theobturator, a smooth, uniform and/or consistent transition from theobturator tip to the periphery of the distal open end of the trocar ismaintained. In accordance with various embodiments, the tip skirtdiffers from the compressible portions, such as the elastic taper, inthat the tip skirt does not specifically conform to the various innerdiameters of the various sized trocars, but conforms specifically to thegeometry of the distal open end of the trocar, e.g., the various shapesand diameters of the distal open end of the various sized trocars.

In accordance with various embodiments, the tip is retractable ormovable proximally when the ribs 16 are compressed. In one embodiment,the tip is extendable or movable distally when the ribs 16 are notcompressed or under less compression. In one embodiment, a tip skirt isreleased or expanded when the ribs are not compressed or under lesscompression and/or the tip is extended and/or in one embodiment the tipskirt is captured, restricted or compressed when the ribs are compressedand/or the tip is retracted.

In accordance with various embodiments, the obturator includes a visualpathway providing visualization before, during and/or after tissuetraversal of the obturator through and into the patient via an endoscopeor the like connected or inserted through the shaft of the obturator.The tip or portions thereof may be transparent and/or include mirrors,windows or lens to enhance or optimize visualization. In accordance withvarious embodiments, the obturator may only include or also include agaseous or fluidic pathway to provide for instance insufflation and/orvisualization. For example, the tip may include one or more vents oropenings allowing gas to pass from the proximal end of the obturatoroutside the patient and connected to a gas source through the obturatorshaft and out the opening in the tip of the obturator.

In accordance with various embodiments, spacing between the ribs and thetip relative to the distal open end of the trocar provides one or morepathways or channels allowing gas to pass from the proximal end of theobturator along the outer surface and/or through the shaft of theobturator and out a space between the ribs, tip and distal open end ofthe trocar. In one embodiment, the space is sufficient to allow gas flowbut not significant to provide an undercut or space that can causetissue coring or trauma. In accordance with various embodiments, the tipof the obturator has cutting edges or blades and/or includes one or moreshields to cover the cutting edges or blades when not in use. Thecompressible portion such as the ribs in one embodiment may beincorporated with the shield or placed adjacent to the shield. Thecompressible portion engaging with the various sized inner diameters ofthe respective various sized trocars ensure a stable (wobble-free)obturator regardless of trocar size thereby providing stable cutting,separating, insufflating and/or visualization. In accordance withvarious embodiments, the compressible portions also provides for astatic or constant centering or positioning of the tip or center portionof the tip as desired by the particular tip relative to the distal endof the trocar and prevents potential tissue coring or trauma.

In accordance with various embodiments, the obturator is a monolithicstructure and in one embodiment the obturator is made from polycarbonateor polyester. The obturator is arranged such that it does not scrape theinner wall of the trocar or cannula portion of the trocar. Thecompressible portions of the obturator in accordance with variousembodiments is sufficiently strong to contact and be flush with varioussizes of the inner diameters of various sized trocars and sufficientlyweak to not introduce scrapping, strain or added friction against theinner diameters of the various sized trocars to prevent damage or undueforces or interactions that increase insertion and/or removal force,e.g., preventing insertion of the obturator into the trocar or removingthe obturator out of the trocar. The compressible portions of theobturator in accordance with various embodiments is also sufficientlycompressible to adjust to various sized trocars for multiple uses suchthat the portions don't snap, fracture or break after continued use. Thecompressible portions in various embodiments are not twistable, bendableor able to change along the curvature of the trocar. The compressibleportions in one embodiment is rigid axially and compressible only in aradial direction towards the center shaft of the obturator. In variousembodiments, the compressible portions surround a center shaft of theobturator in which the center shaft is entirely rigid, not twistableand/or not bendable.

In accordance with various embodiments, the compressible portion, shaftand tip together form a monolithic structure. The core seal and/or depthlimiter may be made of polycarbonate, polyester and/or made of the samematerial as the elongate shaft. In various embodiments, the core seal,depth limiter, shaft and tip, individually, all together or in variouscombinations thereof, are made of a non-elastomeric material and/or arenot adjustable, adaptable or compressible. In accordance with variousembodiments, the obturator is not insertable into a vessel or urinarytract, the obturator being not bendable, flexible or too hard totraverse the vessel or urinary tract.

In accordance with various embodiments, the compressible portions of theobturator are non-inflatable. In one embodiment, the compressibleportion further comprises at least one rib having an initial state beingfully extended and delimiting a first diameter and the at least one ribhaving a compressed state delimiting a diameter about half to aboutfifteenth the size of the first diameter. In one embodiment, the tip hasa hardness to penetrate the surgical access device and in one embodimentthe tip has a hardness to penetrate the body wall. In accordance withvarious embodiments, the shaft may be rigid non-bendable and/or solidand not hollow. In one embodiment, the compressible portion may be solidand not hollow and/or the handle may be solid and not hollow with nocavities or apertures.

It should also be appreciated that the obturator may have provided withthe depth limiter or stepped or expanded proximal portion without thecompressible portion, e.g., ribs, and vice versa. It should also beappreciated that the core seal could be incorporated or extended intothe compressible portion, the depth limiter or both. It should also beappreciated that the core seal could be tapered, conical or shaped ordimensioned in a manner not cylindrical but able to seal against theaperture of the instrument seal used for both the largest trocar orcannula and the smallest trocar or cannula and various sizes between thelargest and smallest trocars. It should also be appreciated that theobturator may have provided with the depth limiter and/or thecompressible portion without the core seal.

In accordance with various embodiments, a surgical access devicecontacts the body and trocars are inserted through this access device.The obturator is inserted into the working channel of the cannula of thetrocar and together they are pushed through the access device with apenetration or insertion force of sufficient magnitude to result inpenetration through the access device. The access device in oneembodiment is used to line and/or protect the incision or entry siteinto the patient's body.

Some of these access devices are introduced into regions that include afluid or gas under pressure. For example, the pressure may be from agas, such as an insufflation gas. As such, it is desirable to providefor the introduction of the surgical instrument into the cavity withoutpermitting the escape of the pressurized fluid or gas. In someembodiments, trapped air, gas or fluid within the cannula or thepressure against the access device can cause resistance to the insertionof the obturator and trocar combination through the access device.Likewise, material or portions of the access device through which theadaptable obturator and trocar combination is inserted therethrough canalso cause resistance to the insertion of the trocar through the accessdevice. Accordingly, maintaining predictable insertion force and feelprovided by the obturator in accordance with various embodiments canfacilitate the insertion of the trocar into the access device. Thus,unintended stress experienced by the access device due to insertion ofthe trocar can be avoided.

Examples of such access devices are illustrated in FIGS. 20-22 in whichan access system 200 comprises a retractor or body wall liner 206 and acap 204. The retractor or surgical wound retractor 206 is placed and/orpositioned into, across, and/or through a surgical incision and/or bodyorifice to enlarge, reshape, and/or isolate the incision or bodyorifice. The cap provides an artificial body wall through whichinstruments and/or trocars access the interior of a patient's body, forexample, a body cavity. This and other embodiments of access devicesystems are described in U.S. Patent Publication No. 2007/0088204 A1,the entire disclosure of which is hereby incorporated herewith byreference.

In one embodiment, the retractor 206 comprises an inner or distal ring210, an outer or proximal ring 212, and a sleeve or retraction sheath214 extending between and coupling the inner ring and the outer ring.The inner ring is flexible and compliant to be compressed and/ordeformed for insertion through an incision and/or body orifice. Whensubsequently released within an associated body cavity, the inner ringsubstantially returns to its original shape or footprint.

A cap or cover used with or without the retractor seals the openingbetween the body cavity and the area outside the body cavity whileproviding access into the body cavity from outside the body cavity. Inone embodiment, the cap releasably and sealingly couples to the outerring of the wound retractor. The cap comprises a cap ring dimensionedand configured for coupling to the outer ring of the wound retractor anda pad coupled to the cap ring. Embodiments of the cap provide anartificial body wall with consistent properties compared with a naturalbody wall, for example, thickness, compliance, rigidity, uniformity, andthe like.

In some embodiments, the pad comprises a gel. In some embodiments, thegel pad does not comprise any preformed access channels therethrough,for example, for instrument access. Trocars and/or instruments may beinserted directly through the gel pad, puncturing the gel pad, andthereby creating access channels or portions in the gel pad. Each accessportion forms an instrument seal in the presence of an instrumentinserted therethrough and a zero seal in the absence of an instrumentinserted therethrough. The gel provides a gas tight seal around avariety of shapes and sizes of instruments inserted therethrough.Embodiments of the gel pad have a working diameter of from about 40 mmto about 120 mm, which is the diameter of a portion of the gel padthrough which instruments and/or trocars may be inserted. Embodiments ofthe gel cap are typically from about 10 mm to 50 mm wider than theworking diameter.

Accordingly, embodiments of the gel cap maintain pneumoperitoneum duringmultiple instrument exchanges and substantially prevent unintentionalloss of pneumoperitoneum. Embodiments of the gel cap also providesubstantially continuous access and visibility during surgery.Embodiments of the gel cap have a small profile for use in procedureswith limited surgical space.

In some embodiments, the gel is an ultragel, which is characterized byan ultimate elongation greater than about 1000 percent and a durometerless than about 5 Shore A. Some embodiments of the ultragel comprisingKRATON® and mineral oil exhibit an ultimate elongation exceeding about1500 percent and improved sealing properties, for example, sealing withinstruments of a wider size range than other seal materials. In someembodiments, the seals comprising ultragels also form zero seals whenthe instrument is removed therefrom. Accordingly, in some embodiments ofseals comprising ultragels, a single seal is acts as both the instrumentseal as well as the zero seal.

Some embodiments of the gel pad comprise an elastomeric gel. Examples ofsuch gels are described in U.S. patent application Ser. No. 10/381,220,filed Mar. 20, 2003, the disclosure of which is hereby incorporated byreference as if set forth in full herein. As discussed above,embodiments of the gel cap comprise no preformed access channels in thegel pad. In use, instruments may be inserted directly through the gelpad, thereby creating access channels through the gel pad. Each accesschannel created in the gel cap forms an instrument seal in the presenceof an instrument passing therethrough because the gel provides a gastight seal around a variety of shapes and sizes of instruments. When theinstrument is removed from the gel pad, the channel created in the gelpad by the instrument closes to form a zero seal. In accordance withvarious embodiments, the gel is not susceptible to coring, tearing ordamage provided by undercuts and/or spacing between the tip of theobturator and the distal end of the trocar. In one embodiment, spacingbetween the ribs and the tip relative to the distal open end of thetrocar provides one or more enlarged pathways or channels allowing gasto pass from the proximal end of the obturator along the outer surfaceand/or through the shaft of the obturator and out a space between theribs, tip and distal open end of the trocar for example to increase gasflow, reduce material and/or ease manufacturing but can cause tissuecoring but not coring into an access system such as a gel pad.

Because the gel cap in various embodiments initially comprises no accesschannels, the surgeon is at liberty to determine the placement ofinstruments therethrough. Moreover, the surgeon has unlimitedflexibility in the placement and repositioning of ports within the areaof the gel cap, as well as the option of selecting different trocarsizes for different clinical procedures. Being detachable, the gel capallows for the removal of large specimens. Once removed, the gel cap canbe re-coupled for example to the outer ring of the wound retractor,thereby restoring the seal and allow the surgeon to re-insufflate thebody cavity.

Moreover, embodiments of the gel are deformable without losing physicalintegrity, and while maintaining substantially gas tight instrumentseals with any instruments extending therethrough, as well as gas tightzero seals for any access channels without any instruments extendingtherethrough. Accordingly, embodiments of the gel cap permit bothtranslational or positional, and angular or pivotal “float” or degreesof freedom for the instruments passing through the gel pad. This floatpermits instrument motion both relative to the cap ring as well asrelative to other instruments. In contrast, other single or limited portsystems do not exhibit one or both translational or angular float forinstruments.

In various embodiments of a gel cap, the gel cap comprises a pluralityof access ports, seals, or sealing valves 220 disposed in or embedded inthe gel pad. The lengths of the access ports in one embodiment aresimilar to the thickness of the gel pad, which is shorter than a lengthof a trocar inserted in the gel pad. The reduced length of the accessport allows increased angular or pivotal motion for instrumentsextending therethrough, and also pet its the use of curved and/or angledinstruments. In the some embodiments, the access ports are substantiallypermanent or non-removable under the conditions under which the gel capis used.

In some embodiments, the trocar or the cannula body of the trocar iscomparatively short because the cannula body only traverses the gel pad,which has a known and consistent thickness, rather than a body wall.Accordingly, some embodiments of the cannula body are not more thanabout 2-times longer, about 1.5-times longer, about 1.2-times longer, orabout 1.1-times longer than the thickness of the gel pad. In someembodiments, the cannula body is less than about 20 mm, about 10 min, orabout 5 mm longer than the thickness of the gel pad. In someembodiments, the cannula body is about as long as the gel pad is thick.In other embodiments, the cannula body has a different length, forexample, a length typical for a cannula used for traversing a body wall.Shorter length cannula bodies permit increased angular degrees offreedom for instruments passing therethrough. Embodiments of shortercannula bodies also accommodate curved instruments. The trocar comprisesany suitable biocompatible material. In some embodiments, the trocarcomprises a flexible material.

In embodiments in which the trocar and obturator are inserted through agel pad, potential damage to underlying tissue by contact with the tipis reduced because the gel pad serves as an artificial body wall that isspaced from the underlying tissue as discussed above. The adaptableobturator is inserted into the trocar and together they are pushedthrough the gel pad with a penetration or insertion force of sufficientmagnitude to result in penetration through the gel pad. In oneembodiment, multiple sized trocars are provided for use with the accessdevice, e.g., the gel pad, and thus a corresponding number of obturatorssized to be used with such trocars are also provided. However, inaccordance with various embodiments of the adaptable obturator, such anobturator replaces the numerous obturators previously provided for usewith such access devices and thereby reducing or eliminating material,manufacturing, packaging and other similar expenses and operatingconfusion while maintaining or not varying the insertion force utilizedor tactile feedback provided. Thus, a single adaptable obturator can beused with multiple various sized trocars. Accordingly, in variousembodiments, it is the single adaptable obturator that conforms to thedimensions of the cannula and not the cannula conforming to thedimensions of the obturator and thereby providing a consistent ornon-obstructive access pathway and internal and/or external cannulasurfaces avoiding for example tissue trauma and/or instrumentobstructions or potential damage.

Although this application discloses certain embodiments and examples, itwill be understood by those skilled in the art that the presentinventions extend beyond the specifically disclosed embodiments to otheralternative embodiments and/or uses of the invention and obviousmodifications and equivalents thereof. Further, the various features ofthese inventions can be used alone, or in combination with otherfeatures of these inventions other than as expressly described above. Assuch, it should be appreciated that although specific combinations ofembodiments and features or aspects of various embodiments may not beexplicitly described such combinations however are contemplated andwithin the scope of the present inventions. Thus, it is intended thatthe scope of the present inventions herein disclosed should not belimited by the particular disclosed embodiments described above, butshould be determined only by a fair reading of the claims.

1. (canceled)
 2. An obturator insertable into at least two differentsized trocars, the obturator comprising: an elongate shaft having aproximal end and a distal end; a handle at the proximal end of theelongate shaft; a tip at the distal end of the elongate shaft; and atleast one compressible portion disposed between the handle and the tipand not extending past the tip, the at least one compressible portionhaving an initial state delimiting a first diameter and the at least onecompressible portion movable to a compressed state delimiting a seconddiameter smaller than the first diameter.
 3. The obturator of claim 2wherein the at least one compressible portion is at least onecompressible rib.
 4. The obturator of claim 3 further comprising a gapbetween the at least one compressible rib and the elongate shaft, thegap between the at least one compressible rib and the elongate shaftdiminishing in size as the at least one compressible rib moves from theinitial state to the compressed state.
 5. The obturator of claim 3further comprising a core seal between the handle and the at least onecompressible rib and the core seal being as rigid as the elongate shaftand the at least one compressible rib extending only between the coreseal and the tip.
 6. The obturator of claim 3 wherein the at least onecompressible rib comprises a plurality of compressible ribs spacedcircumferentially around the elongate shaft.
 7. The obturator of claim 3wherein the at least one compressible rib moves towards the elongateshaft as the least one compressible rib moves from the initial state tothe compressed state.
 8. The obturator of claim 3 wherein the at leastone compressible rib is curvilinear.
 9. The obturator of claim 3 whereinthe at least one compressible rib has a gap along the at least onecompressible rib.
 10. The obturator of claim 3 wherein the at least onecompressible rib extends up to a gap portion separating a proximal endof the at least one compressible rib with a prong.
 11. The obturator ofclaim 3 wherein the at least one compressible rib is not twistable orinflatable.
 12. The obturator of claim 3 further comprising acompressible sleeve covering the at least one compressible rib, thecompressible sleeve and the at least one compressible rib having aninitial state delimiting a first diameter and the compressible sleeveand the at least one compressible rib compressible to a compressed statedelimiting a diameter smaller than the first diameter.
 13. The obturatorof claim 3 wherein the at least one compressible rib is movable only ina radial direction towards and away from the elongate shaft.
 14. Atrocar system comprising: a first trocar having a seal assembly and acannula with a inner diameter and a length; an obturator insertable intothe first trocar, the obturator comprising: an elongate shaft having aproximal end and a distal end; a handle at the proximal end of theelongate shaft; a tip at the distal end of the elongate shaft, the tipbeing as rigid as the elongate shaft; and a compressible portiondisposed between the handle and the tip and not extending past the tip,the at least one compressible portion delimiting a first diametergreater than the inner diameter of the cannula and compressible todelimit a second diameter smaller than the inner diameter of thecannula.
 15. The trocar system of claim 14 wherein the obturator furthercomprises a depth limiter disposed near the handle; wherein a lengthbetween the depth limiter to the tip is longer than the length of thecannula.
 16. The trocar system of claim 14 wherein the obturator has aninsufflation pathway.
 17. The trocar system of claim 14 furthercomprising a surgical access device with the obturator and first trocaradapted to extend through the access device.
 18. The trocar system ofclaim 17 wherein the surgical access device further comprises a gelmaterial.
 19. The trocar system of claim 14 wherein the compressibleportion, elongate shaft and tip form a monolithic structure.
 20. Thetrocar system of claim 19 wherein the compressible portion, elongateshaft and tip are made from the same material.
 21. The trocar system ofclaim 14 wherein the obturator further comprises a core seal disposedbetween the handle and the at least one compressible portion; whereinthe seal assembly of the first trocar has an instrument seal and thecore seal has a sealing relationship with the instrument seal when theobturator is inserted fully through the first trocar and furthercomprising a second trocar having a seal assembly with an instrumentseal and the core seal has a sealing relationship with the instrumentseal when the obturator is inserted fully through the second trocar.